Noncardiac surgical procedures in patient supported with long-term implantable left ventricular assist device.
BACKGROUND
Left ventricular assist devices (LVADs) are increasingly used as bridges to transplantation or as destination therapy. As sicker and older patients are more frequently considered for mechanical support, general surgical problems are expected to increase in these patients.


METHODS
Anesthesia records and clinical charts were reviewed for 11 recipients of LVADs undergoing 12 general surgical procedures between January 1988 and March 2007.


RESULTS
Eight patients underwent major surgical procedures: 1 intracranial hematoma drainage, 1 right hemicolectomy with ileocolostomy, 1 splenectomy, 1 surgical repair of an iliac-femoral artery pseudoaneurysm, 2 cholecystectomies, 1 pyelolithotomy, and 1 coil embolization of a femoral side-branch disruption. Four patients underwent minor surgical procedures. The mean duration of LVAD support before surgery was 58.7 +/- 45.6 days. All patients survived the procedures.


CONCLUSIONS
Noncardiac surgery in LVAD recipients is feasible, without significant morbidity or mortality. Intraoperative coagulation management has a key role in safely performing these procedures.
Garatti
Andrea
A
Department of Cardiovascular Disease E. Malan, Policlinico San Donato Hospital, Milan, Italy. agaratti@tiscali.it
Bruschi
Giuseppe
G
Colombo
Tiziano
T
Russo
Claudio
C
Milazzo
Filippo
F
Catena
Emanuele
E
Lanfranconi
Marco
M
Vitali
Ettore
E
D000328:Adult; D000368:Aged; D005260:Female; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000009:adverse effects; D013997:Time Factors